Contact — Perfect Teeth for Kids

Schedule An Appointment

Schedule Online

Not quite ready to schedule?

Request An Appointment!

Please fill out the form below and one of our friendly team members will give you a call to confirm!**

Parent/Guardian Name

First Name

Last Name

Patient Name

Please only submit ONE Patient per form. If you have multiple children, please fill out this information for each child.

First Name

Last Name

Phone

(###)

###

####

Patient Type

Appointment Type

Tell Us About Your Child

How did you find us?

** This is not an automatic appointment form. Your appointment is not confirmed until you receive a call from the office to set a time and date for your visit. We appreciate your understanding and can’t wait to see you!